Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation
- 76 Downloads
It has been documented that the smooth and move procedure—smoothing the proximal humeral surface while maintaining the coracoacromial arch—can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure.
We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%).
In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023).
In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
KeywordsIrreparable rotator cuff tear Smooth and move procedure Clinical outcomes Active abduction Active flexion
We thank Susan DeBartolo, University of Washington, Department of Orthopaedics and Sports Medicine, for her editorial work on this manuscript.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This was a Level II prospective cohort study approved by our Institutional Review Board (STUDY00004686). For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Armstrong AD, Athwal GS. Rotator cuff tears. 2017; Rosemont, IL: OrthoInfo, American Academy of Orthopaedic Surgeons (AAOS) https://orthoinfo.aaos.org/en/diseases%2D%2Dconditions/rotator-cuff-tears/. Accessed November 13, 2018
- 4.Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, Stobbs G, Yamaguchi K (2010) Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am 92(16):2623–2633. https://doi.org/10.2106/JBJS.I.00506 CrossRefGoogle Scholar
- 6.Vincent K, Leboeuf-Yde C, Gagey O (2017) Are degenerative rotator cuff disorders a cause of shoulder pain? Comparison of prevalence of degenerative rotator cuff disease to prevalence of nontraumatic shoulder pain through three systematic and critical reviews. J Shoulder Elb Surg 26(5):766–773. https://doi.org/10.1016/j.jse.2016.09.060 CrossRefGoogle Scholar
- 13.Boorman RS, More KD, Hollinshead RM, Wiley JP, Mohtadi NG, Lo IKY, Brett KR (2018) What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elb Surg 27(3):444–448. https://doi.org/10.1016/j.jse.2017.10.009 CrossRefGoogle Scholar
- 14.Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Harrell F, Holloway BG, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW, Group MS (2016) 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elb Surg 25(8):1303–1311. https://doi.org/10.1016/j.jse.2016.04.030 CrossRefGoogle Scholar
- 15.Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway BG, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW, Group MS (2013) Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elb Surg 22(10):1371–1379. https://doi.org/10.1016/j.jse.2013.01.026 CrossRefGoogle Scholar
- 18.Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway GB, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW (2014) Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am 96(10):793–800. https://doi.org/10.2106/JBJS.L.01304 CrossRefGoogle Scholar
- 20.Keener JD, Patterson BM, Orvets N, Chamberlain AM (2018) Degenerative rotator cuff tears: refining surgical indications based on natural history data. J Am Acad Orthop Surg. Epub ahead of print https://doi.org/10.5435/JAAOS-D-17-00480
- 24.Pedowitz RA, Yamaguchi K, Ahmad CS, Burks RT, Flatow EL, Green A, Wies JL, St Andre J, Boyer K, Iannotti JP, Miller BS, Tashjian R, Watters WC 3rd, Weber K, Turkelson CM, Raymond L, Sluka P, McGowan R (2012) American Academy of Orthopaedic Surgeons clinical practice guideline on: optimizing the management of rotator cuff problems. J Bone Joint Surg Am 94(2):163–167CrossRefGoogle Scholar
- 27.Agout C, Berhouet J, Spiry C, Bonnevialle N, Joudet T, Favard L, French Arthroscopic S (2018) Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: prospective multicenter study in 68 patients. Orthop Traumatol Surg Res 104(8S):S189–S192. https://doi.org/10.1016/j.otsr.2018.08.003 CrossRefGoogle Scholar
- 32.Ranebo MC, Bjornsson Hallgren HC, Norlin R, Adolfsson LE (2018) Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up. J Shoulder Elb Surg 27(9):1622–1628. https://doi.org/10.1016/j.jse.2018.03.011 CrossRefGoogle Scholar
- 33.Seker V, Hackett L, Lam PH, Murrell GAC (2018) Evaluating the outcomes of rotator cuff repairs with polytetrafluoroethylene patches for massive and irreparable rotator cuff tears with a minimum 2-year follow-up. Am J Sports Med 46(13):3155–3164. https://doi.org/10.1177/0363546518801014 CrossRefGoogle Scholar
- 39.Hirahara AM, Andersen WJ, Panero AJ (2017) Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop (Belle Mead NJ) 46(6):266–278Google Scholar
- 40.Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, Ohue M, Neo M (2018) Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med 46(5):1077–1083. https://doi.org/10.1177/0363546517753387 CrossRefGoogle Scholar
- 41.Mihata T, Lee TQ, Hasegawa A, Kawakami T, Fukunishi K, Fujisawa Y, Itami Y, Ohue M, Neo M (2018) Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Med 46(11):2707–2716. https://doi.org/10.1177/0363546518786489 CrossRefGoogle Scholar
- 42.Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W (2018) Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: short-term clinical outcomes and the radiographic parameter of superior capsular distance. Arthroscopy 34(6):1764–1773. https://doi.org/10.1016/j.arthro.2018.01.009 CrossRefGoogle Scholar
- 44.Piekaar RSM, Bouman ICE, van Kampen PM, van Eijk F, Huijsmans PE (2018) Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear. Musculoskelet Surg 102(3):247–255. https://doi.org/10.1007/s12306-017-0525-5 CrossRefGoogle Scholar
- 46.Rajnish RK, Chouhan DK, Agarwal S (2018) Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: clinical and radiographic results of 39 retrospectives cases-is the pain relief enough? Arthroscopy 34(8):2268–2269. https://doi.org/10.1016/j.arthro.2018.05.013 CrossRefGoogle Scholar
- 47.Ruiz Iban MA, Lorente Moreno R, Ruiz Diaz R, Alvarez Sciamanna R, Paniagua Gonzalez A, Lorente Gomez A, Diaz Heredia J (2018) The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results. Knee Surg Sports Traumatol Arthrosc 26(12):3848–3854. https://doi.org/10.1007/s00167-018-5083-3 CrossRefGoogle Scholar
- 50.Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK (2013) Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am 95(21):1920–1926. https://doi.org/10.2106/JBJS.M.00122 CrossRefGoogle Scholar
- 51.Kany J, Grimberg J, Amaravathi RS, Sekaran P, Scorpie D, Werthel JD (2018) Arthroscopically-assisted latissimus dorsi transfer for irreparable rotator cuff insufficiency: modes of failure and clinical correlation. Arthroscopy 34(4):1139–1150. https://doi.org/10.1016/j.arthro.2017.10.052 CrossRefGoogle Scholar
- 52.Kolk A, Henseler JF, Overes FJ, Nagels J, Nelissen R (2018) Teres major tendon transfer in the treatment of irreparable posterosuperior rotator cuff tears. Bone Joint J 100-B(3):309–317. https://doi.org/10.1302/0301-620X.100B3.BJJ-2017-0920.R1 CrossRefGoogle Scholar
- 58.Pogorzelski J, Horan MP, Godin JA, Hussain ZB, Fritz EM, Millett PJ (2018) Achilles tendon allograft-augmented latissimus dorsi tendon transfer for the treatment of massive irreparable posterosuperior rotator cuff tears. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-2943-8
- 59.Wagner ER, Woodmass JM, Welp KM, Chang MJ, Elhassan BT, Higgins LD, Warner JJP (2018) Novel arthroscopic tendon transfers for posterosuperior rotator cuff tears: latissimus dorsi and lower trapezius transfers. JBJS Essent Surg Tech 8(2):e12. https://doi.org/10.2106/JBJS.ST.17.00062 CrossRefGoogle Scholar
- 66.Sevivas N, Ferreira N, Andrade R, Moreira P, Portugal R, Alves D, Vieira da Silva M, Sousa N, Salgado AJ, Espregueira-Mendes J (2017) Reverse shoulder arthroplasty for irreparable massive rotator cuff tears: a systematic review with meta-analysis and meta-regression. J Shoulder Elb Surg 26(9):e265–e277. https://doi.org/10.1016/j.jse.2017.03.039 CrossRefGoogle Scholar
- 70.Tashjian RZ, Hung M, Keener JD, Bowen RC, McAllister J, Chen W, Ebersole G, Granger EK, Chamberlain AM (2017) Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. J Shoulder Elb Surg 26(1):144–148. https://doi.org/10.1016/j.jse.2016.06.007 CrossRefGoogle Scholar
- 73.Warner JJ (2001) Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect 50:63–71Google Scholar
- 74.Hsu JE, Hulet DA, McDonald C, Whitson A, Russ SM, Matsen FA, 3rd (2018) The contribution of the scapula to active shoulder motion and self-assessed function in three hundred and fifty two patients prior to elective shoulder surgery. Int Orthop. Epub ahead of print https://doi.org/10.1007/s00264-018-4027-3
- 78.Heuberer PR, Kolblinger R, Buchleitner S, Pauzenberger L, Laky B, Auffarth A, Moroder P, Salem S, Kriegleder B, Anderl W (2016) Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration. Knee Surg Sports Traumatol Arthrosc 24(12):3828–3837. https://doi.org/10.1007/s00167-015-3739-9 CrossRefGoogle Scholar
- 80.Maillot C, Harly E, Demezon H, Le Huec JC (2018) Surgical repair of large-to-massive rotator cuff tears seems to be a better option than patch augmentation or debridement and biceps tenotomy: a prospective comparative study. J Shoulder Elb Surg 27(9):1545–1552. https://doi.org/10.1016/j.jse.2018.05.023 CrossRefGoogle Scholar
- 81.Verhelst L, Vandekerckhove PJ, Sergeant G, Liekens K, Van Hoonacker P, Berghs B (2010) Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: mid-term follow-up results in 34 shoulders. J Shoulder Elb Surg 19(4):601–608. https://doi.org/10.1016/j.jse.2009.10.001 CrossRefGoogle Scholar